Provider Demographics
NPI:1942056700
Name:STARS AND STRIPES HEALTHCARE LLC
Entity type:Organization
Organization Name:STARS AND STRIPES HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DINAMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIARENZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-383-8360
Mailing Address - Street 1:10380 SW VILLAGE CENTER DR # 195
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-1931
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10640 SW WATERWAY LANE.
Practice Address - Street 2:
Practice Address - City:PORT ST.LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987
Practice Address - Country:US
Practice Address - Phone:214-383-8360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty